Dr Papadogeorgakis NDepartment of Oral and Maxillofacial Surgery, Dental School, University of Athens.rn

Although clinical and histological factors have helped in predicting survival in patients with oral squamous cell carcinoma, there has been need for more specialized diagnostic and prognostic factors. The research has focused on discovering biologic markers, as well as factors related to the morphology of the neoplastic cells and tissues, which can be studied through computer-aided image analysis. Image analysis methods are divided into two categories: conventional methods, which usually focus on the size of the nuclei and more modern and accurate methods, which produce, by means of fractal analysis, results that can be proved to be mathematically reliable. These methods assess the nuclear complexity and the complexity of other structures of the neoplastic tissue such as the vascular complexity. Image analysis methods and especially fractal analysis, confirm mathematically the pathologist’s subjective assessments. The aim of this article is to review fractal analysis applications in the study of oral cancer and to show its usefulness in diagnosis and prognosis. More specifically this study focuses on fractal dimensions, and especially nuclear fractal dimension (FD) and vascular fractal dimension (VFD), as prognostic factors in oral cancer.

Many cancer patients use dietary supplements concurrently with medications, raising concern for harmful supplement-drug interactions. Supplements and medications for 65 patients initially presenting at the Block Center for Integrative Cancer Treatment during the period 2004-2007 were obtained from intake questionnaires and medical records. Interactions were analyzed using the Natural Medicines Comprehensive Database, which ranks and assesses interactions. 48% of subjects used drugs and supplements concurrently; concurrent users averaged 6.7 supplements and 2.4 drugs. 131 different supplements were used; 135 unique interactions were detected. Six interactions were ranked as “major.” Only low-level scientific evidence supported the validity of most interactions.

In nasopharyngeal carcinoma (NPC), COX-2 inhibitors have been reported to exhibit dose-dependent growth inhibition of these cancer cells, but their interaction with radiation has yet been studied. Here, we examined the effects of selective COX-2 inhibitors SC-236 and NS-398 on the radiosensitivity of NPC cells. When incubated with COX-2 inhibitors prior to irradiation, increased radiation cell kill was documented. However, when the sequence of COX-2 administration was reversed, we observed radioprotection instead. Our findings hereby confirmed the enhancement effect of COX-2 inhibitors on radiation cell kill in vitro, but this effect is critically dependent on their sequence of administration.

Intra-arterial infusion of chemotherapy agents for cancer of the head and neck has been used for several decades. Subsequent advances in vascular radiology techniques have enabled superselective arterial infusion to head and neck structures, and a specific concomitant chemotherapy protocol for head and neck cancer that employs the pharmacologic principles of IA cisplatin while capitalizing on the cisplatinneutralizing agent sodium thiosulfate has shown promising results. This article provides the historical background, rationale, and current state of our research on the use of this treatment regimen for patients with advanced nasal and paranasal sinus carcinoma.
Intra-arterial infusion of chemotherapy agents for cancer of the head and neck has been used for several decades. This article provides the historical background, rationale, and current state of our research on the use of this treatment regimen for patients with advanced nasal and paranasal sinus
carcinoma.1

Background: Hepatic surgery is presumed to improve survival of patients with liver metastases (LM) from neuroendocrine tumours (NET). This study identified LM-specific variables that could be used as additional selection criteria for aggressive treatment.
Methods: A novel classification of LM from NET was established based on their localization and presentation.
Results: From 1992 to 2006, 119 patients underwent staging and treatment of LM. Three growth types of LM were identified radiologically: single metastasis (type I), isolated metastatic bulk accompanied by smaller deposits (type II) and disseminated metastatic spread (type III). The three groups differed significantly in terms of chronological presentation of LM, hormonal symptoms, Ki-67 index, 5-hydroxyindoleacetic acid and chromogranin A levels, lymph node involvement, presence of bone metastases and treatment options. The 3-, 5- and 10-year disease-specific survival rates for the entire cohort were 76.4, 63.9 and 46.5 per cent respectively. There were significant differences in survival between the three groups: 5- and 10-year rates were both 100 per cent for type I, 84 and 75 per cent respectively for type II, and 51 and 29 per cent for type III.
Conclusion: The localization and biological features of LM from NET defines therapeutic management and is predictive of outcome.

Genetic or epigenetic alterations in Barrett’s esophagus (BE) with/without Helicobacter pylori (H. pylori) infection remain unclear. We examined the effects of H. pylori infection on genetic instability (GIN), the CpG island methylation status and a biomarker related to BE carcinogenesis. We analyzed 113 Japanese individuals with endoscopically suspected BE. The patients included, Group CLE (n=25): no specialized intestinal metaplasia (SIM) in a columnar lined epithelium (control); Group BE (n=88): all had SIM. Microsatellite instability and a loss of heterozygosity as GIN, the methylation status at hMLH1, E-cadherin, p16 and APC, and immunoreactivity using a monoclonal antibody (mAb) Das-1, which specifically reacts with BE, were evaluated. Nine additional patients with BE were prospectively followed up for 2 yrs after successful H. pylori eradication. The frequency of GIN, methylation at E-cadherin and APC, and mAb Das-1 reactivity in Group BE was significantly higher than that in Group CLE (p<0.0001, p<0.0001, and p<0.005, and p<0.0001, respectively). Furthermore, GIN, E-cadherin methylation and mAb Das-1 reactivity showed a significantly higher incidence in patients with H. pylori infection than in those without H. pylori infection (p<0.01, p<0.005, and p<0.01, respectively). Interestingly, the patients from Group BE were observed to change to a stable state of molecular alterations in 60% for GIN, 42.9% for E-cadherin methylation and 55.6% for APC methylation, or a reduction of mAb Das-1 reactivity was noted in 25% following eradication. H. pylori infection may therefore affect these molecular alterations associated with the pathogenesis of BE, to some degree, in the Japanese population.